Diabetes mellitus.

1. Diabetes mellitus is diagnosed by finding a random plasma glucose > 11 mmol/L, or a fasting plasma glucose > 8 mmol/L. The prevalence in the general population is between 1-2% rising to approximately 4-9% in the age group 65+ (Williams, 1985; Croxson et al., 1991). It is more prevalent in people from the Indian subcontinent and in Afro-Caribbeans. 2. Approximately 75% of patients can be treated without recourse to insulin. The development of non-fasting ketonuria and/or significant weight loss suggests the onset of insulin dependence. These patients should be referred for specialist advice rapidly. 3. Chronic, uncontrolled hyperglycaemia greatly increases the risk of developing diabetic eye, nerve and kidney complications. 4. Treatment and follow-up aim: to abolish symptoms, to prevent and/or treat diabetic complications, to promote self-care and self-monitoring by patients, to avoid iatrogenic problems from overtreatment, to promote optimum nutrition for these patients. 5. Advice and assessment from the following specialists need to be built into the treatment plan: dietitian, competent fundoscopist (eg optometrist, general practitioner, hospital specialist depending upon local circumstances), chiropodist, diabetes education nurse and diabetes nurse specialist. 6. All patients need appropriate education about: the nature of diabetes mellitus, the importance of good control and the early detection of complications, a healthy lifestyle, the consequences of diabetes for driving and insurance. 7. All patients with diabetes should be reviewed clinically at least once a year. Diet, understanding of diabetes, self-monitoring, metabolic control and complications should be assessed. More frequent clinical review is required in poorly controlled patients, or those with significant complications, or intercurrent illness.(ABSTRACT TRUNCATED AT 250 WORDS)